Provider Demographics
NPI:1831125335
Name:MAPLE LTC GROUP, LLC
Entity Type:Organization
Organization Name:MAPLE LTC GROUP, LLC
Other - Org Name:CORNERSTONE NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-523-9094
Mailing Address - Street 1:PO BOX 948
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28335-0948
Mailing Address - Country:US
Mailing Address - Phone:910-892-8843
Mailing Address - Fax:910-891-1945
Practice Address - Street 1:711 SUSAN TART RD
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-5557
Practice Address - Country:US
Practice Address - Phone:910-892-8843
Practice Address - Fax:910-891-1945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0482314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805284Medicaid
NC7806627Medicaid
NC3436122Medicaid
NC3445325Medicaid
NC0093TOtherBC/BS OF NC
NC0093TOtherBC/BS OF NC
NC3445325Medicaid